The Promise of Combining Radiation Therapy and Immunotherapy: Morbidity and Toxicity

Agassi, Andre M.; Myslicki, Francisco A.; Shulman, Jesse; Rotterman, Yosef; Dosoretz, Daniel E.; Férnández, Eduardo F.; Mantz, C.A.; Finkelstein, Steven E.

doi:10.2217/fon.14.188

Cited by 8 publications

(6 citation statements)

References 32 publications

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“…In the USA, more than 50 clinical trials are currently testing the addition of radiation therapy to various immunotherapies. 81,82 Strong efforts should be made to identify the correct dose, fractionation, target volumes and sequencing with the best immunotherapy agent. As a new role for radiation therapy is emerging as a radiation-driven immunotherapy, four extremely important final considerations should be made for our Radiation Oncology community.…”

Section: Radiation Induced Abscopal Effectsmentioning

confidence: 99%

Radiobiology of stereotactic body radiation therapy (SBRT)

Garau

2017

Reports of Practical Oncology & Radiotherapy

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a b s t r a c tRecent advances in the technology of radiotherapy have enabled the development of new therapeutic modalities that deliver radiation with very high accuracy, reduced margins and high dose conformation, allowing the reduction of healthy tissue irradiated and therefore minimizing the risk of toxicity. The next step was to increase the total tumor dose using conventional fractionation (which remains the best way to relatively radioprotect healthy tissues when large volumes are treated) or to use new fractionation schemes with greater biological effectiveness. Based on the experience gained in radiosurgery, the latter way was chosen for small and well-defined tumors in the body. Stereotactic body radiotherapy delivers high doses of radiation to small and well-defined targets in an extreme hypofractionated (and accelerated) scheme with a very high biological effectiveness obtaining very good initial clinical results in terms of local tumor control and acceptable rate of late complications.In fact, we realize a posteriori that it was not feasible to administer such biologically equivalent dose in a conventional fractionation because the treatment could last several months.So far, these new therapeutic modalities have been developed due to technologic advances in image guidance and treatment delivery but without a solid biological basis. It is the role of traditional radiobiology (and molecular radiobiology) to explain the effects of high doses of ionizing radiation on tumor and normal tissues. Only through a better understanding of how high doses of ionizing radiation act, clinicians will know exactly what we do, allowing us in the future to refine our treatments. This article attempts to describe through simple and understandable concepts the known aspects of the biological action of high doses of radiation on tumor and normal tissues, but it is clear that we need much more basic research to better understand the biology of high doses of radiation.

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Section: Radiation Induced Abscopal Effectsmentioning

confidence: 99%

Radiobiology of stereotactic body radiation therapy (SBRT)

Garau

2017

Reports of Practical Oncology & Radiotherapy

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“…The latter is strongly driven by the immune system [20,21]. The induction of an immunological response may thus form the basis for combining radiation therapy with immunotherapies to cure cancer not only locally but also systemically [22,23]. Changes in the immune contexture can be used to monitor and/or predict cancer therapy outcome [24].…”

Section: Radiation As a Modulator Of Inflammation -The Role Of Tumor mentioning

confidence: 99%

Modulation of inflammation by low and high doses of ionizing radiation: Implications for benign and malign diseases

et al. 2015

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“…During ipilimumab treatment with standard dose of 3 mg/kg, 60-80% patients have immune-related adverse events (ir-AEs) [15]. Diarrhea and skin rash are the most common ir-AEs, other adverse effects include hepatitis, hypophysitis, iridocyclitis, pancreatitis, nephritis and neuropathies [51]. The ir-AEs with grades 3-4 are observed in 10-15% patients, mostly diarrhea and colitis.…”

Section: Toxicity and Response Evaluating Criteriamentioning

confidence: 99%